The following investigations are not routinely recommended for the specialist assessment of bothersome LUTS by NICE (CG97).A. Flow rate
The NICE LUTS guidance 2010 recommends that in the specialist assessment of a patient with LUTS, the clinician should offer: An assessment of general medical history to identify possible causes and co-morbidities, including a review of all current medication (including herbal and over-the-counter medication) that may be contributing to the problem A physical examination guided by symptoms and other medical conditions, an examination of the abdomen and external genitalia, and a DRE (Jones et al., 2010).
Further tests include a flow rate and post-void residual volume measurement as well as a urinary frequency volume chart. Men should be offered information, advice and time to decide if they wish to have PSA testing if; their LUTS are suggestive of benign prostatic enlargement or the prostate gland feels abnormal or they are concerned about prostate cancer.
The guidance only recommends a cystoscopy and/or imaging of the upper urinary tract when there is a history of recurrent infection, sterile pyuria, haematuria, pain or chronic retention.